Another PSA concern.

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erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/17/2010 9:50 AM (GMT -6)   
My biopsy was accomplished on Jan 12, 2010, and the Dx was received about a week or so later. Of course it was PC.
My PSA had been as follows:
01-25-08 3.2
04-25-09 6.1
05-21-09 5.35
08-05-09 5.37
10-27-09 6.93
12-29-09 7.34
01-12-10 Got the rather unwanted biopsy result 3+4=7
02-06-10 6.09
02-15-10 Started Bicalutamide (50mg daily for three months)
02-25-10 Received the Lupron LHRH shot (3-4 months Depot)
03-17-10 5.0
04-24-10 0.7 = drastic drop in Psa.
Took the very last Bicalutamide yesterday 5/16 and the Lupron hot flashes are still not really bad but are now more frequent. Wonder how long this drug (on the average) will be causing these hot flashes????

OK, now does that PSA drop between 3-17 to 4-24 from 5.0 down to 0.7 indicate that the prostate has really had a major shrinkage??
Exactly one week from today, I will be getting my second Volume Study and that will determine IF I'll be getting seeds alone or will have to have some supplemental Radiation to preceed the seeds. Please keep me in your thoughts (I'd say prayers but I don't want to offend anyone).
Bob, down in Southern Colorado


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/17/2010 1:29 PM (GMT -6)   
In my earlier post, I neglected to ask if anyone here has any idea how many gy's I'd probably be expected to receive in the event they want to give me some supplemental radiation (IMRT or IGRT) PRIOR to the seeds. Anyone have any ideas??????????????? Many thanks.
Bob, down in Southern Colorado


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 5/17/2010 2:50 PM (GMT -6)   
Bob,
The HT should shrink your prostate about 50%. This could have been done with Casodex and Proscar and saved you the side affects of Lupron. Most radiologists give Lupron, but they don't understand that Casodex and Proscar will shrink it more with about 20% of the side affects.
Standard IMRT is now about 81 gy. A combination or seeds and IMRT will give about 130 to 150 gy with the same side affects as IMRT only.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/18/2010 1:57 PM (GMT -6)   
John, thanks for responding. I was almost giving up on any imput on my PSA concern. Thought sure I would get a lot more opinions. Oh well, I don't add much to the HW site so guess I can't really expect very much either.
Bob, down in Southern Colorado


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/18/2010 4:30 PM (GMT -6)   
Oops, sorry my above post was worded that way. I guess I can blame it on the blasted Lupron. Makes my thinking process a little wacky lately.
Bob, down in Southern Colorado


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 5/18/2010 4:31 PM (GMT -6)   

Yes, Bob, we keep careful tabs on all posts and determine the exact amount added to HW and thereby respond in kind.

(Before someone takes me seriously, I am just kidding. Bob, you asked a difficult question. I surmise that most have no idea regarding an answer. Hopefully others will reply. At least this reply bounces it up).

 

Mel

 

 


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/19/2010 8:43 AM (GMT -6)   
Mel, thanks for the response and the "bump". Looks like no more opinions from our fellow PC'rs.
Bob, down in Southern Colorado


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/19/2010 9:56 AM (GMT -6)   
Bob,  You asked about the length of time for the hot flashes to go away.  I can only speak from my own experience.  I had a 3 month lupron shot prior to scheduled brachy.  It took about 8 or 9 months from the date of injection to get back to normal.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/19/2010 10:07 AM (GMT -6)   
Carlos, thanks for your feedback. That's exactly what I was wondering about - some AVERAGE time of how long it takes for the 3 month Lupron to really wear off. I realize that we are all different and this stuff will most likely affect each individual in a different way but now I at least have a time line to shoot for. I'm almost 3 months out from the Lupron shot and I'm getting more hot flashes each day. Never really bad but just a greater number of them daily.
Also, I note you indicated that you had the Lupron shot prior to your scheduled brachy. Did you go ahead with the brachy or decide to go robotic surgery instead, as your post indicates? Just wondering.
Bob, down in Southern Colorado


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/19/2010 10:18 AM (GMT -6)   
Bob,  I had scheduled both brachy and surgery while I was trying to decide what to do.  Brachy with IMRT was probably the treatment of choice given my age.  However, I live in a mid sized community and the uros and radiation oncologists just don't keep track records.  In the end I opted for an experienced out of town surgeon. 
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 5/19/2010 4:36 PM (GMT -6)   
Well Carlos, I know what you mean about living in a mid-sized community. I live just outside of a little town with a 9,000 population. Our hospital here does at least have an X-Ray machine and maybe even a CT scanner (don't know if anyone here knows how to run it though). If I have to receive IMRT radiation here in my area, then Pueblo, CO would be the nearest facility offering those treatments. That would mean a 200 mile round trip drive five days per week for who knows how many weeks. That would sure put a lot of miles on the car and with the fuel and time involved, I have chosen to make just one 1,000 mile trip up to Chicago for the Brachy and IMRT (IF the IMRT is deemed necessary) At least I do have a daughter up in the Chicagoland area who'll gladly put the OLD man up for how ever long it takes. My neighbors here just couldn't understand why I'd go so far for these treatments. After explaining the proximity thing, they then understand. Since I'm coming up on the 74th birthday, I have decided that I don't really want to risk the POSSIBLE nasty side effects of surgery that I have read so much about here on HW. So, it's the Brachy route for this old codger.
Bob, down in Southern Colorado

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